Introduction: Malnutrition is a growing problem but quite often under-recognised in elderly people. Calf circumference (CC) is a simple measurement that can be used to identify elderly people who are at high risk of malnutrition; however, a population-specific cut-off point must be developed. Therefore, this study aimed to determine suitable cut-off points and evaluate the predictive value of the CC cut-off point for elderly Malaysians.
Methods: A total of 820 persons comprising 433 men and 387 women were recruited as subjects. The mean age was 69.0 ± 6.8 and ranged between 60 to 97 years. Data were collected from Sabak Bernam, Selangor; Kuala Pilah, Negeri Sembilan; Pasir Mas, Kelantan, and Kodiang, Kedah. A linear regression analysis with the z-score procedure by gender was used to derive the CC prediction equations.
Results: The CC cut-off points for men and women at risk of malnutrition were 30.1 cm and 27.3 cm, respectively. The final predictive CC equations for men was CC (cm) = 3.69 (z score) + 33.81, R2 = 1 and CC (cm) = 0.7103 (BMI) + 18.54, R2 = 1; and for women, CC (cm) = 4.31 (z score) + 31.63, R2 = 1 and CC (cm) = 0.6698(BMI) + 16.847, R2 = 1. Based on these equations, using the z-score equal to negative 1 for men (BMI 16.30 kg/m2 ) and women (BMI 15.64 kg/m2 ), the mean of the predictive value of the CC cut-off point was 32.0 ± 4.2 cm in men and 30.5 ± 4.6 cm in women.
Conclusion: It is suggested that these cut-off points be used to screen elderly individuals who are at risk of malnutrition. Further studies should be undertaken to further verify the application of the findings of this study.
Introduction: Detailed clinical information is important for the Casemix System to
generate valuable Case Based Group (CBG) for malnourished geriatric patients. Clinical
coding for malnutrition provides useful information on the nutritional health of patients
for treatment purposes.
Methods: This cross-sectional study with purposive sampling
involved a total of 130 geriatric patients (>60 years) at Hospital Universiti Sains Malaysia
(USM). Nutritional assessments were performed such as anthropometrics measurement,
Subjective Global Assessment (SGA), and biochemical assessment. The patients’ medical
records and coded data were systematically reviewed to observe the documentation of
nutritional information and coding criteria based on the International Classification for
Diseases (ICD-10).
Results: The prevalence of malnutrition among the geriatric patients
was 35.4%. Proper documentation of required nutritional information was found in less
than 50% of the cases. None of the malnourished patients were documented and coded
with malnutrition diagnosis, despite being given nutritional interventions. The reasons
given for this omission were related to the lack of awareness (50%) and incomplete
medical documentation (50%). Further analysis revealed that uncoded diagnosis,
miscoding, missing, and unavailable codes for nutritional counselling and oral nutritional
supplementation were the main contributors to the incomplete records.
Conclusion:
The quality of clinical coding for malnourished geriatric patients in the hospital should
be improved. A structured assessment and standard documentation is recommended to
improve the quality of healthcare provision for malnourished geriatric patients.
Introduction: Compliance with medical nutrition therapy is important to improve patient outcomes. The purpose of this study was to determine dietary compliance and its association with glycemic control among outpatients with poorly controlled type 2 diabetes mellitus (T2DM) in Hospital Universiti Sains Malaysia (HUSM).
Methods: In this cross-sectional study, patients who had a glycosylated hemoglobin (HbA1c) level of at least 6.5%, after attending a diet counseling session at the Outpatient Dietetic Clinic, HUSM, were enrolled. Out of 150 diabetic patients reviewed between 2006 and 2008, 61 adults (32 men and 29 women) agreed to participate in this study. A questionnaire-based interview was used to collect socio-demographic, clinical and diabetes self-care data. The patient’s dietary compliance rate was determined by the Summary of Diabetes Self-Care Activities (SDSCA) measure. Anthropometric and biological measurements were also taken.
Results: Only 16.4% of the respondents adhered to the dietary regimen provided by dietitians. Among the 7 dietary self-care behaviours, item number 6 (eat lots of food high in dietary fibre such as vegetable or oats) had the highest compliant rate (54.1%); whereas item number 3 (eat five or more servings of
fruits and vegetables per day) had the lowest compliant rate (23.0%). There was a significant association between gender (p=0.037) and fasting blood sugar (FBS) (p=0.007) with the compliance status. Conclusion: Dietary non-compliance is still common among T2DM patients. Dietitians need to improve their skills and use more effective intervention approaches in providing dietary counseling to patients.
Keywords: Dietary compliance, diet counseling, type 2 diabetes mellitus
This study aimed to develop demi-span equations for predicting height in the Malaysian elderly and to explore the applicability of previous published demi-span equations derived from adult populations to the elderly.
INTRODUCTION: In most Asian countries, stroke is one of the major causes of mortality. A stroke event is life-changing for stroke survivors, which results in either mortality or disability. Therefore, this study comprehensively focuses on prevalence, risk factors, and secondary prevention for stroke recurrence identified in South, East, and Southeast Asian countries.
METHODS: This scoping review uses the methodological framework of Arksey and O'Malley. A comprehensive search of academic journals (English) on this topic published from 2007 to 2017 was conducted. A total of 22 studies were selected from 585 studies screened from the electronic databases.
RESULTS: First-year stroke recurrence rates are in the range of 2.2% to 25.4%. Besides that, modifiable risk factors are significantly associated with pathophysiological factors (hypertension, ankle-brachial pressure index, atherogenic dyslipidaemia, diabetes mellitus, metabolic syndrome, and atrial fibrillation) and lifestyle factors (obesity, smoking, physical inactivity, and high salt intake). Furthermore, age, previous history of cerebrovascular events, and stroke subtype are also significant influence risk factors for recurrence. A strategic secondary prevention method for recurrent stroke is health education along with managing risk factors through a combination of appropriate lifestyle intervention and pharmacological therapy.
CONCLUSION: To prevent recurrent stroke, health intervention should be geared towards changing lifestyle to embody a healthier approach to life. This is of great importance to public health and stroke survivors' quality of life.
INTRODUCTION: Hospitalised elderly patients are at high risk of malnutrition due to the presence of chronic diseases and inadequate food intake. It was on this premise that a Malnutrition Risk Screening Tool-Hospital (MRST-H) was developed for identifying the risk of malnutrition among Malaysian elderly patients.
METHODS: A total of 181 respondents aged 65 years and above who had been admitted to the Geriatric Ward of the University Malaya Medical Centre were recruited. The respondents' nutritional assessment was assessed using the Global Indicator of Malnutrition (GIM), a reference gold standard of malnutrition consisting of anthropometric measurements, biochemical indicators and the Subjective Global Assessment (SGA). Important predictive factors of malnutrition were determined by logistic regression analysis.
RESULTS: Five out of 18 predictive factors were significantly associated with malnutrition (p<0.05) in the final multivariate logistic regression model. These five factors were used to develop the MRST-H. Its validity was tested among 100 elderly inpatients in the Kuala Lumpur Hospital. The MRST-H was found to have 66.7% sensitivity, 96.2% specificity and 82.4% positive predictive value to GIM. The MRST-H was tested for reliability among 40 patients involving three raters (a dietitian and two nurses). The Kappa index of agreement was excellent between the dietitian with nurse A (81.3%, Kappa=0.84) and nurse B (87.5%, Kappa=0.89) respectively.
CONCLUSION: The MRST-H developed showed high validity and reliability as a screening tool for identifying hospitalised elderly patients with high risk of malnutrition.
Persons with disabilities (PWD) are susceptible to malnutrition. Caregivers or teachers in rehabilitation centres may not be adequately trained in nutrition management of PWD. The aims of this study were (i) to assess the nutrition knowledge, attitude and practice among teachers in community-based rehabilitation centres for PWD; and (ii) to evaluate changes in the nutrition knowledge and attitude of the teachers before and after exposure to a training workshop on nutrition management for PWD.